Autogenous Particulate Cancellous Bone Research Articles

Towards Optimum Mandibular Reconstruction for Dental Occlusal Rehabilitation: From Preoperative Virtual Surgery to Autogenous Particulate Cancellous Bone and Marrow Graft with Custom-Made Titanium Mesh-A Retrospective Study.

The purpose of this retrospective study was to evaluate computer-assisted virtual surgery and the outcomes of mandibular reconstruction using an autogenous particulate cancellous bone and marrow (PCBM) graft combined with a custom-made titanium mesh (TiMesh) using a three-dimensional (3D) printing model. Eighteen consecutive patients were included, and preoperative virtual simulation surgery was performed using digital data. Segmental bone defects showed deviation of the mandible due to displacement of the condyle and segments, unnatural length of the mandibular body, or poorer intermaxillary relationship compared to the marginal bone defect caused by previous operations. These mandibular disharmonies could be simulated, and virtual surgery was performed on a computer with adjustment of displaced mandibular segments, length of the mandibular body, and dental arch with digital bone augmentation. TiMesh was manually pre-bent using a 3D printing model, and PCBM from the iliac crest was grafted with TiMesh. The short-term clinical results were good; reconstruction of the alveolar crest was prosthetically desirable; and minor complications were observed. In conclusion, virtual reconstruction is crucial for treating complex deviated mandibles. Accurate condylar and dental arch positions with an optimum mandibular length are important for prosthetically satisfactory mandibular reconstruction.

The advantages and disadvantages of jaw reconstruction with ULTRA FLEX MESH CUSTOM<sup>®</sup> and autogenous particulate cancellous bone and marrow

The advantages and disadvantages of jaw reconstruction with ULTRA FLEX MESH CUSTOM<sup>®</sup> and autogenous particulate cancellous bone and marrow

Mandibular reconstruction using autogenous particulate cancellous bone and marrow harvested from the tibia and a custom-made titanium mesh tray: A case report

Mandibular reconstruction using autogenous particulate cancellous bone and marrow harvested from the tibia and a custom-made titanium mesh tray: A case report

Clinical Usefulness of Mandibular Reconstruction Using Custom-Made Titanium Mesh Tray and Autogenous Particulate Cancellous Bone and Marrow Harvested From Tibia and/or Ilia.

The objective of this study was to evaluate usefulness of mandibular reconstructions using custom-made titanium mesh (Ti-mesh) tray and particulate cancellous bone and marrow (PCBM). Consecutive 21 patients who underwent mandibular reconstruction were enrolled in this study. They were 13 men and 8 women (mean age, 52.0 years). Virtual reality simulation was performed using computer software based on the preoperative computed tomography data. A 3-dimensional skull model was constructed using 3-dimensional printer. A tray was custom-made from Ti-mesh sheet bent to adapt to the model. After PCBM harvesting from posterior ilia and/or proximal tibia, the tray was fixed to the host bone. New bone formation and configuration of the reconstructed mandible were assessed radiologically. Complications were recorded in each patient during the follow-up period. Patients' satisfaction with postoperative facial contour was evaluated using visual analog scale (VAS score, range, 0-100). In 16 of 21 patients, excellent new bone formation was recognized and expected results were radiologically achieved. In 5 patients, new bone formation was insufficient. Causes of insufficient bone formation included postoperative infection in 2 patients, Ti-mesh tray fracture in 2 patients, and local recurrence of lower gingival cancer in 1 patient. To prevent a tray fracture, a double-layered Ti-mesh tray was useful. Mean VAS score on patients' satisfaction was 77.1. Our results comprehensively suggest that mandibular reconstruction using custom-made Ti-mesh tray and PCBM is clinically useful.

Clinical usefulness of mandibular reconstruction using custom-made titanium mesh tray and autogenous particulate cancellous bone and marrow harvested from tibia and/or ilia

The objective of this study was to evaluate usefulness of mandibular reconstructions using custom-made titanium mesh (Ti-mesh) tray and particulate cancellous bone and marrow (PCBM). Consecutive 21 patients who underwent mandibular reconstruction were enrolled in this study. They were 13 men and 8 women (mean age, 52.0 years). Virtual reality simulation was performed using computer software based on the preoperative computed tomography data. A 3-dimensional skull model was constructed using 3-dimensional printer. A tray was custom-made from Ti-mesh sheet bent to adapt to the model. After PCBM harvesting from posterior ilia and/or proximal tibia, the tray was fixed to the host bone. New bone formation and configuration of the reconstructed mandible were assessed radiologically. Complications were recorded in each patient during the follow-up period. Patients' satisfaction with postoperative facial contour was evaluated using visual analog scale (VAS score, range, 0-100). In 16 of 21 patients, excellent new bone formation was recognized and expected results were radiologically achieved. In 5 patients, new bone formation was insufficient. Causes of insufficient bone formation included postoperative infection in 2 patients, Ti-mesh tray fracture in 2 patients, and local recurrence of lower gingival cancer in 1 patient. To prevent a tray fracture, a double-layered Ti-mesh tray was useful. Mean VAS score on patients' satisfaction was 77.1. Our results comprehensively suggest that mandibular reconstruction using custom-made Ti-mesh tray and PCBM is clinically useful.

Evaluation of Mandibular Reconstruction With Particulate Cancellous Bone Marrow and Titanium Mesh After Mandibular Resection Due to Tumor Surgery

There are numerous treatment modalities for mandibular defects after tumor surgery. Autogenous particulate cancellous bone marrow graft combined with titanium mesh (PCBM-MESH) is an alternative procedure. The purpose of this study was to evaluate PCBM-MESH for mandibular reconstruction. There were a total of 10 cases from 2000 to 2011. Mandibles were successfully reconstructed in 9 cases; however, reconstruction failed in 1 case. Overall, the recovery of facial contours was excellent; conversely, the evaluation of prosthetic treatment varied widely. Thus, we suggest 3 steps for mandibular reconstruction: (1) recover the continuity of bone segments; (2) simulate optimum facial contours and dental occlusion; and (3) perform the occlusion with dental prostheses. PCBM-MESH is a valuable method for mandibular defects-particularly for restoring facial contours and a favorable alveolar ridge.

カスタムメイド・チタンメッシュトレーと自家腸骨／脛骨海綿骨骨髄細片による下顎骨再建の臨床的有用性（原著）

カスタムメイド・チタンメッシュトレーと自家腸骨／脛骨海綿骨骨髄細片による下顎骨再建の臨床的有用性（原著）

Mandibular reconstruction using a poly(l-lactide) mesh combined with autogenous particulate cancellous bone and marrow: a prospective clinical study

The purpose of this study was to evaluate the stability and viability of mandibular bone regeneration using a poly(l-lactide) (PLLA) mesh and autogenous particulate cancellous bone and marrow (PCBM). Sixty-two procedures were undertaken at eight hospitals (22 malignant tumours, 30 benign tumours, five cysts, two osteomyelitis, two trauma, and one atrophy of the alveolar ridge); the success rate was 84%. The follow-up period was between 9 and 200 months (mean 88.2 months). Consequently, bone regeneration at 6 months postoperation was excellent in 35 cases (57%), good in 17 cases (27%), and poor in 10 cases (16%). In six of the ‘poor’ cases, the PLLA mesh was removed due to local infection early after surgery. Bone resorption>20% was observed in only one of 46 cases with a follow-up term of >1 year. There were no signs of any other adverse effects except in one case where a section of the tray broke off late in the follow-up period. It is concluded that this method is stable and effective due to favourable morphological and functional recovery and low invasiveness. It may thus be a useful alternative procedure for mandibular reconstruction.

カスタムメイド・チタンメッシュトレーと自家海綿骨骨髄細片を用いた下顎骨再建

本論文では，著者らが行っているカスタムメイド・チタンメッシュトレーと自家海綿骨骨髄細片を用いた下顎骨再建術を代表症例を提示しながら紹介する。このチタンメッシュトレーは下顎骨欠損部に正確に適合し，CAD/CAMと歯科技工の技術を駆使することで，個々の患者の最終的な咬合回復に適した外形を備えている。本法を用いて11人の下顎骨欠損患者（9人の区域欠損と2人の辺縁欠損）の下顎を再建した。再建手術は全例とも支障無く終了し，術後の患者の顔貌もほとんどの症例で整容的に十分許容できるものであった。11例中2例のオトガイ部を含む欠損例で術後3ヶ月以内のチタンメッシュトレーの破折を経験したが，海綿骨骨髄細片と補強型チタンメッシュトレーを適用して再手術を行ったところ良好な結果が得られている。以上より本法には若干の改良の余地が残されているものの，従来の再建方法に比べると臨床的により予知性の高い方法であると思われた。

Evaluation of secondary bone grafting of the alveolar cleft in adult cleft lip and palate patients

ObjectiveThe aim of this study was to evaluate 13 adult cleft lip and palate patients who underwent secondary bone grafting using short-term follow-up examinations. Materials and methodsThe subjects were 13 cleft lip and palate patients. The mean age of the subjects were 28.6 years old (range: 20–47 years). Seven of the patients had BCLP, seven had UCLP, and one had UCLA. None of them had BCLA. Autogenous particulate cancellous bone and marrow (PCBM) was grafted onto the alveolar clefts. The marginal bone levels of the grafted bone were assessed by means of periapical films, which were taken after an observation period of six months, according to the Enemark's classification. ResultsEight bone grafted alveoli had scores of 1 (53.3%), six had scores of 2 (40%), and one had score of 4 (6.3%). None had score of 3. The formation of bone bridges was satisfactory in 93% of the bone-grafted alveoli. The postoperative prostheses used in this study (15 bone grafted alveoli) included seven dental implants; one straightening of the teeth alone; one straightening of the teeth and dentures; and two cases in which the prostheses used were unknown. Patients who underwent dental implant surgery had obviously higher score of Enemark's score (1.8) than those without dental implant (3.1). ConclusionThis study confirmed that PCBM grafting of alveolar clefts works as well for adult patients as it does for pediatric patients and the effectiveness of use of implants in the grafted alveoli to the maintenance of the grafted bone.

The effect of platelet-rich plasma on early and late bone healing using a mixture of particulate autogenous cancellous bone and Bio-Oss®: an experimental study in goats

Platelet-rich plasma (PRP), containing various growth factors, may speed up wound and bone healing. Using osteoconductive alloplastic materials in reconstructive surgery, the amount of autogenous bone needed can be reduced. The purpose of this experiment was to study the effect of PRP on a mixture of autogenous bone and deproteinized bovine bone mineral (Bio-Oss) particles in goats. Four, round, critical size defects were made in the foreheads of 20 goats. In all goats the defects were filled with a mixture of autogenous particulate cancellous bone and (Bio-Oss) particles, in which 1 ml of PRP was added in two of the four defects. The goats were allocated to four subgroups each containing five goats, which were killed after 1, 2, 6 and 12 weeks. The results of the histological and histomorphometric examination showed that early and late bone healing were not enhanced when PRP was used.

局所麻酔薬持続投与法による腸骨採取部の疼痛管理の検討

Free iliac bone(autogenous particulate cancellous bone and marrow: PCBM)grafts play an important role in surgical reconstruction of the oral and maxillofacial region. However, postoperative pain at the bone graft donor site is a common problem.Patients usually have difficulty in walking for about 10 days due to postoperative donor site pain. Getting up from bed and discharge are often delayed. Prolonged hospitalization increases the risk of complications such as deep vein thrombosis and pulmonary embolism.For these reasons, we have used a direct continuous local anesthetic injection system with a disposable injection pump at the site of iliac bone grafts.The advantage of this method is the relief of postoperative donor site pain as compared with analgesics such as diclofenac sodium, resulting in shorter hospitalization.

The effect of platelet-rich plasma on early and late bone healing: an experimental study in goats

Four round critical-size defects were made in the foreheads of 20 goats. The defects were filled with autogenous particulate cancellous bone, in which 1 ml of platelet-rich plasma (PRP) was added in two of the four defects of each goat. The goats were divided into four subgroups of five goats each, which were killed after 1, 2, 6 and 12 weeks. The results of histologic and histomorphometric examination showed that early and late bone healing was not enhanced when PRP was used.

Clinical Investigation of Dental Implant Reconstruction for Grafted Alveolar Cleft Patients

The purpose of this study was to evaluate the clinical application of endosseous implants for management of grafted alveolar cleft. Four patients (1 male and 3 female; mean age 26.6 years; age ranging from 21.5 to 30.4 years at first implant surgery) with unilateral cleft lip and palate were evaluated. All patients received autogenous particulate cancellous bone and marrow graft (PCBM) to close the alveolar cleft. After bone bridge formation, implant treatment was performed. All patients with insufficient alveolar bone height, chin or ramus of mandible bone, onlay grafting was performed 4 months before implant installment. A total of 5 implants were placed in the grafted alveoli. The length of implants ranged from 10.0 to 13.0 mm. The follow-up period ranged from 2.2 to 4.1 years after implant placement. The clinical result was acceptable in all patients. The survival rate of implants was 100%. Implant treatment for grafted alveolar cleft was studied and the outcome of treatment was acceptable.

O.483 Histological examination of drill sites in bovine rib bone after grinding with eight different devices in vitro

The aim of this study was to evaluate 13 adult cleft lip and palate patients who underwent secondary bone grafting using short-term follow-up examinations.The subjects were 13 cleft lip and palate patients. The mean age of the subjects were 28.6 years old (range: 20–47 years). Seven of the patients had BCLP, seven had UCLP, and one had UCLA. None of them had BCLA. Autogenous particulate cancellous bone and marrow (PCBM) was grafted onto the alveolar clefts. The marginal bone levels of the grafted bone were assessed by means of periapical films, which were taken after an observation period of six months, according to the Enemark's classification.Eight bone grafted alveoli had scores of 1 (53.3%), six had scores of 2 (40%), and one had score of 4 (6.3%). None had score of 3. The formation of bone bridges was satisfactory in 93% of the bone-grafted alveoli. The postoperative prostheses used in this study (15 bone grafted alveoli) included seven dental implants; one straightening of the teeth alone; one straightening of the teeth and dentures; and two cases in which the prostheses used were unknown. Patients who underwent dental implant surgery had obviously higher score of Enemark's score (1.8) than those without dental implant (3.1).This study confirmed that PCBM grafting of alveolar clefts works as well for adult patients as it does for pediatric patients and the effectiveness of use of implants in the grafted alveoli to the maintenance of the grafted bone.

顎裂部自家腸骨海綿骨細片移植術術後の骨吸収について―梨状孔下縁形態における評価―

Grafting of autogenous particulate cancellous bone and marrow to residual alveolar clefts in patients with cleft lip and palate is a well-established procedure for non-prosthetic rehabilitation with canine eruption into the grafted bone or for maintenance treatment after achieving arch alignment. Various analyses of the effect of grafting have been reported, but nearly all previous studies focused on non-prosthetic rehabilitation. The reconstruction of alveolar bone has been evaluated on only intraoral radiographs.We consider the purposes of bone grafting to the alveolar cleft to be not only non-prosthetic rehabilitation, but also correction of anomalies around the nasal cavity. We evaluated the status of bone bridge formation and bone resorption in 146 unilateral clefts of the prepalate and palate, which underwent bone grafting between 1996 and 2000. We also examined factors related to bone anomalies around both the alveolar ridge and the piriform aperture.Our results showed that age at bone grafting had a signifcant influence on resorption. Thus, we consider the time of bone grafting to be very important. Grafting should be done before 11 years of age and eruption of the canines. In addition, orthodontic space closure, which includes tooth root guidance to the grafted bone after alveolar bone grafting, is necessary for bone bridge formation on the piriform aperture side.

Translational research for injectable tissue-engineered bone regeneration using mesenchymal stem cells and platelet-rich plasma: from basic research to clinical case study.

Translational research involves application of basic scientific discoveries into clinically germane findings and, simultaneously, the generation of scientific questions based on clinical observations. At first, as basic research we investigated tissue-engineered bone regeneration using mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) in a dog mandible model. We also confirmed the correlation between osseointegration in dental implants and the injectable bone. Bone defects made with a trephine bar were implanted with graft materials as follows: PRP, dog MSCs (dMSCs) and PRP, autogenous particulate cancellous bone and marrow (PCBM), and control (defect only). Two months later, dental implants were installed. According to the histological and histomorphometric observations at 2 months after implants, the amount of bone-implant contact at the bone-implant interface was significantly different between the PRP, PCBM, dMSCs/ PRP, native bone, and control groups. Significant differences were also found between the dMSCs/PRP, native bone, and control groups in bone density. These findings indicate that the use of a mixture of dMSCs/ PRP will provide good results in implant treatment compared with that achieved by autogenous PCBM. We then applied this injectable tissue-engineered bone to onlay plasty in the posterior maxilla or mandible in three human patients. Injectable tissue-engineered bone was grafted and, simultaneously, 2-3 threaded titanium implants were inserted into the defect area. The results of this investigation indicated that injectable tissue-engineered bone used for the plasty area with simultaneous implant placement provided stable and predictable results in terms of implant success. We regenerated bone with minimal invasiveness and good plasticity, which could provide a clinical alternative to autogenous bone grafts. This might be a good case of translational research from basic research to clinical application.

間葉系幹細胞とＰＲＰ複合体を用いた上顎洞底拳上術における骨造成法の実験的研究

Recently, minimally invasive surgery based on a tissue engineering has become possible. We used an animal model to evaluate a method for bone regeneration by maxillary sinus floor augmentation that uses mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) instead of an autologous bone graft. The MSCs were isolated from rabbit iliac crest marrow aspirates, and PRP was obtained from peripheral blood. MSCs and PRP complexes were used for grafting. In the control group, autogenous particulate cancellous bone and marrow (PCBM) was collected and mixed with PRP. Histological examination showed that new bone formation was good in both groups at 2 and 4 weeks. At 8 weeks, lamellar bone had formed, but fatty marrow was also observed in both groups.The present results suggest that MSCs/PRP complexes may be used in place of autogenous bone to promote bone regeneration after maxillary sinus floor augmentation.

Injectable bone

Tissue engineering applies the principles of biology and engineering to the development of functional substitutes,for example 1) cells, 2) scaffolds, 3) some cytokines, for lost tissues. The meaning of this bone regeneration is that it decreases the needed tissues and burden of patients. In this time, we applied to mesenchymal stem cells (MSCs) from the own bone marrow as cell sources. MSCs are thought to be multipotent cells that can replicate. And we also used a beta-tricalcium phosphate (beta-TCP) as a scaffold and fibrin glue as materials to regenerate a injectable bone and we injected into the subcutaneous space on the dorsum of the rat. After 8 weeks of implantation, it could be confirmed newly formed bone and fibrin glue functioned as a injectable materials without loosing the cell activity and the proliferation of MSCs. Next we applied Platelet Rich Plasma (PRP) to improve the ability of osteogenesis. PRP contains some cytokines and are expected to promote the increase of osteogenesis. The merit is not immunity rejection from autologous blood collected in the immediate preoperative period. The admixtures of PRP or fibrin glue have fluidity and gel-like consistency as the thrombin mixing. They can be injected with a syringe in tissues. We named this "Injectable Bone". According to the histological observations, the MSCs with PRP were well formed mature bone and neovascularization compared with control (defect only) after 8 weeks implantation. These results demonstrated that the mixture of MSCs and PRP were useful as injectable bone substitute and its ability of bone regeneration is almost equal to autogenous particulate cancellous bone and marrow (PCBM).

Long term follow-up of reconstruction with allogeneic mandibular bone crib packed with autogenous particulate cancellous bone marrow.

Allogeneic mandibular bone processed by the deep frozen method was used as a biologic crib for mandibular reconstruction. The allogeneic mandible is biocompatible, bioresorbable, of low antigenicity and provides the morphology for symphysis contour, angle of mandible and dental arch form. The particulate cancellous bone marrow (PCBM) contains marked osteogenic potential of hematopoietic marrow, which promotes osteogenesis. The cancellous marrow graft lacks structure and requires a crib to house it during the bone regeneration to the consolidation phase. Fresh frozen mandible was hollowed out for packing with PCBM prior to securing it to the defect by a rigid fixation method. Four cases of large mandibular defects resulting from treatment of benign odontogenic tumors were reconstructed utilizing this technique. All cases showed excellent facial contour and function satisfactorily in mastication and pronunciation. Complete graft incorporation and restoration of the osseous continuities were observed for four to 12 years after the operation.